The episode begins with SpongeBob and Patrick singing 'squidward had a krabby patty' at the Krusty Krab. Squidward becomes very annoyed, so he tells them to stop. However, they ignore him and continue singing, so Squidward goes to the door of the kitchen to yell at them, but just as he reaches the door, the door swings open as SpongeBob comes out singing, and it hits squidward in the face. Squidward is in great pain, and yells at SpongeBob to take him to the hospital. At the hospital, SpongeBob is nervously pacing up and down and chewing on Krusty Krab hats, when the Purple Doctorfish opens the door to the waiting room. SpongeBob bursts into tears and asks if Squidward is going to be okay, to which the Doctorfish replies by saying they won't know for two weeks.
There is a bubble transition, and two weeks later, SpongeBob goes into the hospital holding a Bouquet of flowers. He gives one of the flowers to Mable, who is apparently suffering from amnesia, and then he walks into Squidward's operation room. The Purple Doctorfish says that Squidward had asked to keep SpongeBob far away from him, but SpongeBob promises to stay out of the way. Just as the Doctorfish is about to cut the bandages, SpongeBob interrupts him, saying to not rush it. He then interrupts a second time asking if Squidward has enough 'emensmansera', to which the doctor says he has never heard of. SpongeBob interrupts a third time saying the readings on a brain meter (which is actually a television) are wrong, and a forth time with a television programme. SpongeBob interrupts to apologise for interrupting, and then the bandages are finally cut. Squidward's face is so handsome it causes the doctor and a nurse to faint, and when Squidward looks in a mirror, he is thrilled to see he really is handsome.
As Squidward is walking through town, multiple fish see him, call him handsome and faint. One fish crashes a car, and an old lady regains the ability to walk, a blind fish regains the ability to see, and one fish becomes able to fly. Many fish begin taking photographs of Squidward, and one asks for an autograph. Squidward is enjoying the attention. A limo is waiting for Squidward and SpongeBob, which return them to Squidward's house. Many fans follow the limo, and take pictures of Squidward as he walks to his house. Squidward goes to sleep, while a group of fish are chanting 'handsome handsome handsome' outside his house all night. In the morning, Squidward remembers he is handsome, and goes out to greet the crowd, which has grown significantly over night. Suddenly, the fans start trying to take his shirt and eyelids, and Squidward rushes back inside. Squidward instead decides to play them a song on his clarinet, and the crowd cheer for him. But then, someone grabs his clarinet from him as he is leaning out the window, and that fish is attacked by the crowd who also want the clarinet.
Squidward tries to take his mind off the incident by having a herbal bath, but someone reaches through the window and grabs his soap. Squidward tries to enjoy his bath, but a huge fish emerges out of his bath, and then fish start coming through his window, door and even toilet, and try to 'get' him. Squidward jumps out the window, but the crowd is still outside, and they start to approach him. He runs into SpongeBob's house, who is trimming his toenails, and Squidward begs SpongeBob to help him get his old life back. SpongeBob and Squidward cut through the crowd and run to the Krusty Krab, with the crowd chasing after them.
When they arrive, Mr. Krabs is thrilled to see a crowd of people outside the Krusty Krab, and tells the crowd they can pay to touch Squidward. Squidward asks SpongeBob to smash the door in his face before Mr. Krabs opens the doors to the Krusty Krab. SpongeBob doesn't want to hurt Squidward on purpose, but Squidward tells SpongeBob to hurt him or he will hurt SpongeBob, so SpongeBob repeatedly slams the door in Squidward's face. This ends up making Squidward even more handsome, then suddenly a shoe falls through a hole in the roof. Before it hits Squidward in the head, SpongeBob shoves him out of the way, and he stumbles face first into a pole. This returns Squidwards face to normal, and the crowd leaves. In an attempt to bring them back, Mr. Krabs repeatedly slams the door into Squidwards face, to no avail. Then the episode ends.
In this episode, SpongeBob says, "Handsome. But she spelled it wrong." after Squidward asks what Sadie had called him a moment before. This was an inside joke, where the word, "Handsome" was missing the "d" on the storyboards of that scene.
Originally, the thing that was going cause Squidward to get a broken face was a truck. It was changed to SpongeBob slamming the door on his face because it would've been too frightening to be shown.
This episode shows that the characters have an obsession with the alphabet to the point where they can't speak without using it.
The episode is banned in some countries due to the constant hitting Squidward with the door, and the two handsome versions of Squidward.
The original way how Squidward got his face back to normal was that he got hit by a car, but it got changed to a support beam in the Krusty Krab, likely because the original scene would have been too frightening for young viewers.
Purple Doctorfish, the doctor, differs from his previous episodes in terms of mean behavior and voice.
This was Charlie Bean's only episode as writer and storyboard director.
Squidward will have a change in appearance after a head injury into a baby in "Squid Baby."
In the scene where SpongeBob is clipping his toenails, there is incense burning in the background.
During the hospital scene, there is a television set in Squidward's room which Purple Doctorfish said "for the patient's enjoyment," which Squidward can't possibly watch due to the bandages on his head.
Squidward's head was really broken twice in this episode because before Squidward's face was broken in the beginning, he was shown as a thermometer, and when the mercury was reaching to the boiling point, his forehead breaks off.
This is the first time Squidward is on a title card.
The second was in the title card of a later episode called "Oral Report."
The second time they are seen, SpongeBob is wearing his hat.
This is the first episode where Squidward has his face changed physically. The second is "Not Normal."
This is one of the few occasions when Squidward was acting like a friend to SpongeBob.
On Squidward's second "handsome phase" it shows that he wears a belt on his shirt.
Running Gags: Squidward getting hit in the face with the door and whenever Gill Gilliam tries to cut the bandages, SpongeBob shouts: "Wait!" or "Hold it!"
In this episode, Squidward plays his clarinet well, while in others, he is shown to be very bad at it.
During the scene where SpongeBob pushes Squidward out of the way to avoid the other falling bowling shoe (and reverting him back to his old self), the opera Pagliacci's aria "
In the patient's room, when SpongeBob watches television, it shows Fred as a doctor with a female fish.
When SpongeBob is hitting Squidward repeatedly with the door, you hear some cracking noises.
This could mean he is breaking some bones or his face.
Vesti la giubba" by Ruggero Leoncavallo was heard in the background during the scene when Squidward avoids a falling shoe.
Squidward's second "handsome face" became a famous meme and running gag on the internet, being especially used as a Facebook profile picture or on other social sites and galleries.
It has also been used in the One Direction fandom, where a mathematical formula shows One Direction's Zayn Malik being added to Squidward's "even more handsome" stage, resulting in one of the guys from The Wanted.